Term
|
Definition
Spastic bowel or mucous colitis, a motility disorder of the lower GI tract characterized by:
crampy abdominal pain accompanied by diarrhea, constipation or both. There is NO evidence of inflammation. |
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Term
| Irritable Bowel Syndrome: Risk Factors |
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Definition
* Heredity
* Psychological stress: anxiety and/or depression
* Diet high in fat and/or spicy food
* ETOH
* Smoking
* Lactose intolerance |
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Term
| Irritable Bowel Syndrome: Clinical Manifestations |
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Definition
Alteration in bowel pattern: diarrhea/constipation
Abdominal pain: cramping
Pain is aggravated by eating: this can lead to malnutrition
Pain will often be in the area of the sigmoid colon
Bloating/distension
Flatulence |
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Term
| Irritable Bowel Syndrome: Diagnostic Tests |
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Definition
Barium enema
Colonoscopy
Rule out other diseases! |
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Term
| Irritable Bowel Syndrome: Medical Treatment |
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Definition
1. Well-balanced, high-fiber diet
2. Anti-diarrheals
3. Anticholinergics
4. Calcium channel blockers- decrease GI spasms (WATCH out for hypotension!)
5. Zelnorm: decreases nerve impulses to the gut thereby decreasing spasms.
6. Antidepressants
7. Exercise
8. Stress Reduction
9. Bulk-forming laxatives: Metamucil, bran |
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Term
| Irritable Bowel Syndrome: Patient Education |
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Definition
Discuss diet - gradually increase fiber
Encourage patient to increase fluids to prevent constipation: 6 to 8 8-oz glasses per day.
(It is best to consume fluids before and after meals.)
Avoid ETOH
Avoid smoking
Rest and exercise
Medication regimen |
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Term
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Definition
| Inflammation of the vermiform appendix |
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Term
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Definition
*Pain in the periumbilical area that descends to the right lower quadrant
*Abdominal pain that is MOST intense at McBurney's point
*Rebound tenderness
*Abdominal rigidity
*Elevated WBC count
*N/V and anorexia
*Constipation or diarrhea
Low-grade fever
*Client in side-lying position with abdominal guarding and legs flexed |
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Term
| Appendicitis: Diagnostic Tools |
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Definition
Lab Work: Elevated WBC count
Ultrasound
CT scan |
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Term
| Appendicitis: Medical Treatment |
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Definition
Appendectomy:
Open - full incision, if it ihas perforated or is really "hot"
Laparoscopy ("Lap Appy") - if it hasn't ruptured
Antibiotics
IV Fluids
Analgesics |
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Term
| Appendicitis: Complications |
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Definition
Perforation
Peritonitis
Abscess formation - if there is perforation and some bacteria has remained |
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Term
| Appendicitis: Nursing Diagnoses |
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Definition
Alteration in comfort: pain
Risk for FVD
Actual FVD (N/V/D) |
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Term
| Appendicitis: Postoperative Nursing Interventions |
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Definition
1. Monitor temp for signs of infection
2. Assess incision for signs of infection: redness, swelling, pain
3. Maintain NPO until bowel function has returned
4. Advance diet as tolerated once bowel sounds return
5. Position client in a right, side-lying or semi-Fowler's position
6. Change the dressing as prescribed and record type/amount drainage
7. Administer antibiotics and analgesics as prescribed
8. Coughing, deep breathing, turning
9. Get the patient up sometime during that same day/night
10. Monitor for peritonitis |
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Term
| Appendicitis: Discharge Instructions for Lap Appy |
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Definition
Diet as tolerated
Activity as tolerated
No heavy lifting
Back to work within a few days
This is usually same day surgery with much less risk of infection. |
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Term
| Appendicitis: Discharge Instructions for Open Surgical Procedure |
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Definition
Teach patient about:
drain
dressing changes-incision care
antibiotic for home use
limited activity: restrictions for 3-6 weeks
must be medically cleared before returning to work |
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Term
|
Definition
Inflammation of the peritoneum -
This is a serious complication of many acute abdominal disorders. |
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Term
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Definition
| Enteric bacteria entering the peritoneal cavity through a perforated ulcer, ruptured appendix, perforated diverticulum, necrotic bowel, or abdominal surgery. |
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Term
| Peritonitis: Most common bacterial causes |
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Definition
E. coli
Klebsiella
Proteus
Pseudomonas |
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Term
| Peritonitis: Pathophysiology |
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Definition
*Inflammatory process
*Peristaltic activity of bowel ceases - paralytic ileus
*Fluid and air are retained- abdominal distention
*Fluid shifts into abdominal cavity - ascities
*O2 requirements increase due to the large distended abdomen not getting enough oxygen. |
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Term
| Peritonitis: Diagnostic Tools |
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Definition
Lab:
*WBC count (20,000/mm3)
*Electrolytes
Flat plate of abdomen
CT of abdomen |
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Term
| Peritonitis: Signs and Symptoms |
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Definition
Pain over area
Rebound tenderness/guarding of abdomen
Abdominal distention
Board-like rigidity
Increased fever/chills
Anorexia/N/V
Tachycardia
Hypertension
Decreased bowel sounds |
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Term
| Peritonitis: Medical Management |
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Definition
1. ID and treat cause
2. Maintain fluid/electrolyte balance: Isotonic fluids (NS, D5W)
3. Decrease abdominal distention: NG tube for decompression
4. Antibiotic therapy - start with broad spectrum
5. Analgesics for pain
6. Oxygen therapy - O2 needs will increase
7. Antiemetics for N/V |
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Term
| Peritonitis: Surgical Intervention |
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Definition
Excision- take out infected area
Resection - e.g. in diverticulitis
Repair - e.g. in ulcer
Drainage - e.g. in pancreatitis |
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Term
| Peritonitis: Nursing Management |
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Definition
Assess:
* Respiratory issues: patient may need O2
* Pain management: assess often
* Abdominal assessment: listen for bowel sounds
* Fluid and Electrolyte status
* Assess NG tube |
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Term
|
Definition
| Washing of the peritoneal cavity with copious amounts of warm isotonic fluid. This may be done during surgery to dilute residual bacteria and remove gross contaminants, blood and fibrin clots. |
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Term
| Inflammatory Bowel Disease (IBD) |
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Definition
Includes 2 chronic inflammatory disorders:
Ulcerative Colitis
Crohn's Disease
Both have periods of remission and acute exacerbation |
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Term
|
Definition
Autoimmune or allergic response
Enteric pathogens
Environmental agents: pesticides, radiation
Genetic tendency: hereditary |
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Term
|
Definition
| Ulcerative and inflammatory disease of the bowel that results in poor absorption of nutrients. |
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Term
| Ulcerative Colitis: Pathophysiology |
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Definition
*Commonly begins in the rectum and spreads upward toward the cecum
*Colon becomes edematous and may develop bleeding lesions and ulcers and can lead to abscess formation.
*Ulcers may lead to perforations.
*Scar tissue develops and causes loss of elasticity and loss of ability to absorb nutrients.
*Scarring can cause the bowel to shorten and narrow and may cause some constipation or loose diarrhea.
*Colitis is characterized by various periods of remissions and exacerbations.
*Affects only the mucosa and submucosa |
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Term
| Ulcerative Colitis: Demographics |
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Definition
Women, Jewish, and caucasian populations are more likely to have this condition.
Peaks between 30-50 years of age. |
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Term
| Ulcerative Colitis: Clinical Manifestations |
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Definition
*Diarrhea: up to 20 stools a day
*Abdominal pain: colicky spasms in the LLQ (descending colon)
*Intermittent tenesmus: constant feeling of needing to pass stools
*Rectal bleeding: ulcerated, irritated
*Anorexia: loss of appetite/weight loss
*Fever: often
*Arthritis: bone discomfort
*Uveitis: inflammation of the uvea, may involve sclera and cornea |
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Term
| Ulcerative Colitis: Diagnostic Findings |
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Definition
Stool: + for blood
Barium Enema: mucosal irregularities, shortening of colon
Colonoscopy: friable, inflamed tissue (thin & weak tissue)
Decreased H/H and albumin
Elevated WBC, ESR (sed rate) |
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Term
| Ulcerative Colitis: Complications |
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Definition
TOPH
T:Toxic megacolon - colon becomes so distended it can't contract or pass stool
O:Obstruction
P:Perforation
H:Hemorrhage |
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Term
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Definition
| Inflammatory disease that can occur anywhere in the GI tract but most often affects the terminal ileum and leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses. This disease is characterized by remissions and exacerbations. |
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Term
| Crohn's Disease: Demographics |
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Definition
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Term
| Crohn's Disease: Pathophysiology |
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Definition
*Begins as a small inflammatory aphthoid lesion of the mucosa and submucosa of the bowel.
*Initial lesions may regress or the inflammatory process can progress to involve ALL layers of the intestinal wall.
*Inflammation is transmural: can go through all layers.
*Deeper ulcerations can lead to granuloma development
*Fissures: knife-like clefts that extend deeply into the bowel wall
*Lumen of the bowel develops a "cobblestone" appearance
*As disease progresses, fibrotic changes in bowel cause it to thicken and lose flexibility, looks like an old rubber garden hose.
All this leads to:
local obstruction, abscess development, formation of fistulas between loops of bowel and other organs. |
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Term
| Crohn's Disease: Clinical Manifestations |
|
Definition
1. Diarrhea - may contain mucus and pus; possibly steatorrhea due to malabsorption issues (foul-smelling!)
2. Abdominal pain - right lower quadrant
3. Low grade fever
4. Weight loss with malnutrition
5. Abscesses - craters in colon (perforation likely)
6. Autoimmune component: arthritis, uveitis |
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Term
| Crohn's Disease: Diagnostic Findings |
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Definition
WBC - elevated due to abscess formation/inflammation
H/H - low due to blood loss
Albumin/protein - low due to malnutrition
ESR (sed rate) and C-reactive protein - high due to acute inflammation
Colonoscopy with biopsy
Upper GI and Small Bowel series - "string sign" colon is very narrow and constricted, looks like a string.
Barium Enema - cobblestone appearance, fistulas and fissures (bumpy, not nice and smooth) |
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Term
| Crohn's Disease: Complications |
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Definition
Obstruction
F/E imbalances: dehydration
Malnutrition
Abscess formation
Increased risk of colon cancer |
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Term
|
Definition
Avoid irritants
*spicy, fried foods
*caffeine
Eat small, frequent meals
Increase protein
Increase calories
TPN - for the very sick patient
Low-residue diet |
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Term
|
Definition
AVOID:
*ETOH, prune juice
*Whole-grain breads, rolls, cereal; breads or rolls with seeds, nuts, or bran
*Any desserts containing dried fruits, nuts, seeds or coconut; rich pastries, pies.
*Tough or spiced meats, fried meats, highly flavored cheeses
*Potato skins, chips, fried potatoes, brown rice, whole-grain pasta
*Jam, marmalade, candy made with seeds, nuts, coconut
*Raw or whole-cooked vegetables
*Chili sauce, horseradish, popcorn, olives, vinegar |
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Term
|
Definition
Antidiarrheals: Loperamide
Antispasmodics: Bentyl
Aminosalicylates: Sulfasalazine, decrease inflammation
Antibiotics: Flagyl, Cipro
Corticosteroids: Prednisone (watch blood sugar)
Immunosuppresive agents: Cyclosporine, Methotrexate
Immune Response Modifiers: Remicade |
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Term
|
Definition
Total colectomy with ileostomy
Total colectomy with continent ileostomy (Kock pouch)
Colectomy with ileoanal anastomosis
Small bowel resection with anastomosis
Intestinal transplant |
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Term
| IBD: Monitor for potential complications |
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Definition
HOPP
H- hemorrhage
O - obstruction
P - perforation
P - peritonitis |
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Term
Ileostomy Patient: Nursing Management
Pre-op |
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Definition
Abdomen is marked for stoma
Teaching - educate about procedure
Meet psychosocial needs |
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Term
Ileostomy Patient: Nursing Management
Post-op |
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Definition
-VS, dressing, drainage, tubes
-Stoma, color/size
- Fecal drainage, normal stool will be liquid
- IF Kock pouch, drainage catheter
- Maintain NG suction if ordered |
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Term
Ileostomy Patient: Nursing Management
Skin and Stoma Care |
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Definition
-Ostomy bag should be emptied when 1/3-1/2 full
-Change pouch during times of low flow
- Cut pouch to fit stoma
- Face-plate, usually changed every 5-7 days
-Clean skin really well and use a skin prep
-IF there is breakdown: use zinc oxide on skin
-Candida is most common cause of skin infection (due to antibiotic use) |
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Term
Ileostomy Patient: Nursing Management
Dietary and Fluid Needs |
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Definition
Odorous foods: onions, garlic, cabbage, broccoli
Deodorizing foods: yogurt, buttermilk
INCREASE: protein, carbs
DECREASE: fats, residue, caffeine
Small feedings
Check fluids - watch for dehydration
Get daily weights |
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Term
Ileostomy Patient: Nursing Management
Monitor to Prevent Complications |
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Definition
Peristomal skin irritation
Diarrhea
Stomal stenosis
Renal calculi
Cholelithiasis |
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Term
Ileostomy Patient: Nursing Management
Provide Emotional Support |
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Definition
Grief process
Support groups
Pregnancy and normal delivery are possible |
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Term
|
Definition
| Inability of the digestive system to absorb one or more vitamins, minerals or nutrients. |
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Term
|
Definition
Mucosal disorders
Infectious diseases
Postoperative issues
Disorders that cause issues with specific nutrients
Medical disorders |
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Term
| Malabsorption: Clinical Manifestations |
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Definition
Diarrhea
Bulky, foul-smelling stools, look greasy
Gray color due to a lack of bile
Flatulence
Weight loss
Malnutrition |
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Term
| Malabsorption: Diagnostic Testing |
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Definition
Lactose Tolerance
Schilling Test - for B12 deficiency/pernicious anemia
Biopsy of mucosa of small intestine
Fecal analysis
CBC
Hydrogen Breath Test |
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Term
| Malabsorption: Medical Treatment |
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Definition
Avoid the agent that aggravates the condition
Supplemental vitamins and minerals
Antibodies
Antidiarrheal agents
Parenteral fluids for hydration/nutrition |
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Term
| Colorectal Cancer: Risk Factors |
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Definition
Dietary influence
Genetic link
IBD: Crohn's Disease |
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Term
| Colorectal Cancer: Clinical Manifestations |
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Definition
Blood in stools
Change in bowel habits
Anorexia/wt. loss
Anemia
Pain
Obstruction |
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Term
| Colorectal Cancer: Diagnostic Tests |
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Definition
Barium Enema
Colonoscopy: "Gold Standard" BEST
Digital Rectal Exam (DRE)
Stool for occult blood (FOBT)
CEA -Carcinoembryonic Antigen
CT scan |
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Term
| Colorectal Cancer: Surgical Management |
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Definition
*Segmental resection with anastomosis
*AbdominoPerineal (AP) resection with colostomy
*Proctosigmoidectomy - colostomy, everything is removed from the sigmoid colon down. |
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Term
| Colorectal Cancer: Pre-op Nursing Care |
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Definition
Diet
Bowel cleansing - on the morning of, enemas until clear
Antibiotics
Emotional support!
Enterostomal therapist visits the patient
Teaching |
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Term
| Colorectal Cancer:Post-op Nursing Care |
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Definition
Monitor:
*VS
*Abdominal dressing: sutures/staples still intact?
*Stoma - viable, healthy tissue
*Labs
*Pulmonary complications
*Pain
*Thrombophlebitis: get moving the night of surgery |
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Term
| Colorectal Cancer: Ostomy Care |
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Definition
Opening in pouch is cut to 1/8" larger than stoma
Change pouch every 5-7 days
Teach patient how to irrigate
Teach patient about foods that cause odor and gas/foods that decrease odor (Lettuce causes diarrhea)
Patient will need to drink 2L of fluid per day |
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Term
| Colorectal Cancer: Ostomy Irrigation |
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Definition
Use approximately 500-1000 cc fluid
Bag suspended at shoulder height
Insert tip of irrigation tube only 3" (or use a cone) |
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Term
| Colorectal Cancer: Monitor for Complications |
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Definition
Leakage from anastomosis
Prolapse of stoma
Perforation
Fecal impaction |
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Term
| Bowel Obstruction: Two Processes |
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Definition
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Term
| Mechanical Bowel Obstruction |
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Definition
Something blocking the inner lumen:
Adhesions
Intussusception - part of bowel lips in between another part
Volvulus - bowel twists on itself (torsion)
Hernia - abdominal contents protrude out of the abdominal cavity |
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Term
| Functional Bowel Obstruction |
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Definition
| Muscles do not propel the contents forward |
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Term
| Bowel Obstruction: Clinical Manifestations |
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Definition
Crampy abdominal pain
N/V
Blood and mucous passed rectally: small bowel obstruction
Constipation: large bowel obstruction
Abdominal distention
Bowel sounds
Dehydration
Shock
At first, bowel sounds will be increased and high-pitched, then they will go silent. |
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Term
| Bowel Obstruction: Treatment |
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Definition
Decompression of bowel
Treat dehydration
Surgery to treat cause |
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Term
|
Definition
| Out-pouching or herniation of the intestinal mucosa; can occur in any part of the intestine, but it is most common in the sigmoid colon. |
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Term
|
Definition
| Inflammation of one or more diverticula that occurs from penetration of fecal matter through the thin-walled diverticula; it can result in local abscess formation and perforation. |
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Term
| Diverticuliti: Clinical Manifestations |
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Definition
Mild to severe pain in LLQ
Bloating and distention
Abdominal tenderness
Low-grade fever
N/V
Alteration in bowel habits
Blood in stools (less than 15% have this)
Urinary frequency: inflammation may put pressure on the bladder. |
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Term
| Diverticulitis: Diagnostic Tests |
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Definition
Barium Enema
Abdominal X-ray
Colonoscopy
CT scan: might be done first to assess damage
CBC - elevated white count
Sed rate - increased due to inflammation |
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Term
| Diverticulitis: Complications |
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Definition
HOPPA
Hemorrhage
Obstruction
Perforation
Peritonitis
Abscesses - crater scars over and then can lead to obstruction |
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Term
| Asymptomatic Diverticular Disease: Management |
|
Definition
Eat high fiber/low fat diet
Avoid food with seeds: Popcorn, strawberries, raspberries
Take a bulk laxative: Metamucil
Call MD - fever, abdominal pain/tenderness or changes in bowel habits. |
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Term
| Diverticulitis: Management |
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Definition
Clear liquids until inflammation subsides
Antibiotics
Bulk laxative: Metamucil |
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Term
| Acute Diverticulitis: Management |
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Definition
NPO
NG if vomiting present
IV fluids and antibiotics
Pain relief: IV morphine
Antispasmodics: Probanthine, Daricon
Bulk laxative or stool softeners
Surgery |
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Term
| Acute Diverticulitis: Surgical Management |
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Definition
Resection with anastomosis
Remove inflamed area and create a colostomy |
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Term
| Diverticular Disease: Nursing Interventions |
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Definition
Fluid intake
Diet
Bulk laxatives
Stool softeners
Analgesics, antibiotics, antispasmodics
Complications: HOPPA
REST the bowel
25% will have surgery |
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Term
|
Definition
Infection in the perirectal spaces
S/S:
Swelling
Redness
Tenderness
Pain
Fever
Treatment: Incise and drain, antibiotics, sitz baths, packing |
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Term
|
Definition
Tubular tract that extends from an opening beside the anus into the anal canal.
S/S:
Leakage of pus or stool from opening, vagina or bladder
Treatment: fistulectomy |
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Term
|
Definition
Longitudinal tear or ulceration in mucosa of anal canal
S/S:
Painful defecation with burning and bleeding
Treatment: stool softeners, bulk laxative, sitz baths, increase fluids |
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Term
|
Definition
Dilated portions of veins in anal canal
S/S:
Itching
Pain
Bleeding with defecation
Treatment: stool softeners, bulk laxative, sitz bath, increase fluids. |
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Term
|
Definition
Pink to bright red and shiny
This indicates high vascularity |
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Term
| Stoma: Abnormal Appearance |
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Definition
Pale pink: means low hemoglobin/hematocrit levels
Purple-black or dusky: means compromised circulation, call MD |
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